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1.
Niger J Clin Pract ; 24(8): 1133-1137, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34397020

RESUMO

Aims: To investigate alteration of intestinal microflora in uremia patients with or without blood purification treatments. Methods: The present study included a total of 109 adult patients who were administered in our hospital during 2014 August to 2015 December, 85 cases had already received hemodialysis treatment and 24 cases had not received any renal transplantation treatments. Serum levels of hemoglobin, albumin, creatinine, hypersensitive C reactive protein, and cystatin C, as well as blood urea nitrogen and estimated glomerular filtration rate were determined. 16S rRNA sequencing was conducted to determine the levels of Bifidobacterium, Lactobacillus acidophilus, Escherichia coli, and Enterococcus faecalis. Results: The hemoglobin level in the hemodialysis group was significantly higher than that of the non-hemodialysis patients. The levels of Bifidobacterium and Lactobacillus acidophilus were significantly lower while the levels of Escherichia coli and Enterococcus faecalis were significantly higher in both of the patient groups compared with the healthy control. In all treatment groups, levels of Bifidobacterium and Lactobacillus acidophilus were significantly higher and levels of Escherichia coli and Enterococcus faecalis were significantly lower compared with the non-blood purification treatment group. Conclusions: The intestinal microflora might be influenced by uremia and might also be affected by blood purification treatments.


Assuntos
Microbioma Gastrointestinal , Uremia , Adulto , Bifidobacterium , Humanos , Lactobacillus acidophilus , RNA Ribossômico 16S , Uremia/terapia
2.
Medicine (Baltimore) ; 100(25): e26423, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160430

RESUMO

BACKGROUND: Skin pruritus is a common complication in patients with uremia. When the hemodialysis time of patients is extended, and the probability of skin pruritus is greater. Patients often have the symptoms of skin pruritus intolerable, affecting the normal sleep and normal life of patients. The patients with uremic pruritus often constant scratching and pruritus skin, resulting in broken skin, and further symptoms such as infection, and subsequent skin shedding, prurigo nodularis, and other adverse complications, aggravating the patient's condition. Some patients will experience symptoms such as depression and insomnia due to skin pruritus, and simply scratching the skin lead to infection. Severely affected patients may even show suicidal tendency, endangering the physical and mental health of patients, and it is needed to give the effective treatment to patients. Hemodialysis is a common treatment for uremic pruritus, which can effectively relieve the pruritus symptoms of patients. The drugs can also relieve the symptoms and improve the degree of pruritus in patients. And some studies show that traditional Chinese medicine UCG combined with HFH in the treatment of uremic pruritus has a very good effect, Therefore, this study will systematically evaluate the clinical efficacy and safety of UCG combined with HFH and HFH alone in the treatment of uremic pruritus. METHODS: Use computer to search English and Chinese databases, English databases include: PubMed, Web of Science, EMbase, The Cochrane Library. Chinese databases include: CNKI, CBM, WanFang Data and VIP databases, collecting the RCT on the clinical effectiveness and safety of UCG combined with HFH and HFH alone in the treatment of uremic pruritus. The retrieval time is from the beginning of each database to May 1, 2021. In order to improve the retrieval rate of the literature, the references cited in the included research are also collected and screened. Set Chinese and English as the search language. Two members of the research group independently collected, included and excluded the literatures. In case of disagreement, consulting the third party to assist in the judgment. For the literature with missing data, the original author should be contacted as far as possible to obtain complete data. Two evaluators evaluate the bias risk of included studies according to the Cochrane Handbook bias risk assessment tool for RCT. RevMan 5.3 software is used for statistical analysis and the forest plot is drawn to show the outcome indicators and funnel plot is drawn to show the publication bias. RESULTS: This study evaluates the advantages and disadvantages of traditional Chinese medicine UCG combined with HFH and HFH alone in the treatment of uremic pruritus through the clinical effectiveness and safety-related indicators. CONCLUSION: This study will give a positive conclusion on the efficacy and safety of uremic clearance granule in the treatment of uremic pruritus, and the research results will be published in professional journals in the form of academic papers, thus benefiting more patients. ETHICS AND DISSEMINATION: This study belongs to meta-analysis and all data comes from academic papers published publicly in formal academic journals, so there are no ethical issues involved in this study and no ethical review or approval is required. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/W8P5G.


Assuntos
Medicamentos de Ervas Chinesas/administração & dosagem , Falência Renal Crônica/terapia , Prurido/terapia , Diálise Renal/efeitos adversos , Uremia/terapia , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Falência Renal Crônica/complicações , Metanálise como Assunto , Prurido/diagnóstico , Prurido/etiologia , Prurido/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Uremia/diagnóstico , Uremia/etiologia
4.
Stem Cells Dev ; 30(15): 758-772, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074129

RESUMO

Cytokine storm is recognized as one of the factors contributing to organ failures and mortality in patients with COVID-19. Due to chronic inflammation, COVID-19 patients with diabetes mellitus (DM) or renal disease (RD) have more severe symptoms and higher mortality. However, the factors that contribute to severe outcomes of COVID-19 patients with DM and RD have received little attention. In an effort to investigate potential treatments for COVID-19, recent research has focused on the immunomodulation functions of mesenchymal stem cells (MSCs). In this study, the correlation between DM and RD and the severity of COVID-19 was examined by a combined approach with a meta-analysis and experimental research. The results of a systematic review and meta-analysis suggested that the odd of mortality in patients with both DM and RD was increased in comparison to those with a single comorbidity. In addition, in the experimental research, the data showed that high glucose and uremic toxins contributed to the induction of cytokine storm in human lung adenocarcinoma epithelial cells (Calu-3 cells) in response to SARS-CoV Peptide Pools. Of note, the incorporation of Wharton's jelly MSC-derived extracellular vesicles (WJ-EVs) into SARS-CoV peptide-induced Calu-3 resulted in a significant decrease in nuclear NF-κB p65 and the downregulation of the cytokine storm under high concentrations of glucose and uremic toxins. This clearly suggests the potential for WJ-EVs to reduce cytokine storm reactions in patients with both chronic inflammation diseases and viral infection.


Assuntos
Síndrome da Liberação de Citocina/prevenção & controle , Vesículas Extracelulares/fisiologia , Células-Tronco Mesenquimais/citologia , SARS-CoV-2/fisiologia , Geleia de Wharton/citologia , Adulto , Idoso , COVID-19/sangue , COVID-19/complicações , COVID-19/metabolismo , COVID-19/terapia , Células Cultivadas , Técnicas de Cocultura , Síndrome da Liberação de Citocina/genética , Síndrome da Liberação de Citocina/metabolismo , Síndrome da Liberação de Citocina/virologia , Citocinas/genética , Citocinas/metabolismo , Complicações do Diabetes/sangue , Complicações do Diabetes/metabolismo , Complicações do Diabetes/terapia , Complicações do Diabetes/virologia , Diabetes Mellitus/sangue , Diabetes Mellitus/metabolismo , Diabetes Mellitus/terapia , Diabetes Mellitus/virologia , Relação Dose-Resposta a Droga , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Glucose/metabolismo , Glucose/farmacologia , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/fisiologia , Gravidez , Toxinas Biológicas/metabolismo , Toxinas Biológicas/farmacologia , Cordão Umbilical/citologia , Uremia/sangue , Uremia/complicações , Uremia/metabolismo , Uremia/terapia
5.
J Stroke Cerebrovasc Dis ; 30(9): 105819, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33926796

RESUMO

Patients with renal disease have increased rates of admission to the neurological intensive care unit related to overlapping risk factors for renal and cerebrovascular disease as well as unique risks associated with renal dysfunction alone. Management of acute neurological injury in these patients requires individualized attention to diagnostic and management factors as they relate to coagulopathy, disorders of immune function, encephalopathy and renal replacement modalities. Careful consideration of these brain-kidney interactions is necessary to optimize care for this special patient population and improve neurological and renal outcomes.


Assuntos
Infecções/terapia , Unidades de Terapia Intensiva , Hemorragias Intracranianas/terapia , AVC Isquêmico/terapia , Diálise Renal , Insuficiência Renal Crônica/terapia , Uremia/terapia , Encéfalo/fisiopatologia , Humanos , Infecções/diagnóstico , Infecções/mortalidade , Infecções/fisiopatologia , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/fisiopatologia , AVC Isquêmico/diagnóstico , AVC Isquêmico/mortalidade , AVC Isquêmico/fisiopatologia , Rim/fisiopatologia , Recuperação de Função Fisiológica , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/fisiopatologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Uremia/diagnóstico , Uremia/mortalidade , Uremia/fisiopatologia
6.
Toxins (Basel) ; 13(4)2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33807343

RESUMO

Numerous studies have indicated that the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD) is strictly associated with the accumulation of toxic metabolites in blood and other metabolic compartments. This accumulation was suggested to be related to enhanced generation of toxins from the dysbiotic microbiome accompanied by their reduced elimination by impaired kidneys. Intestinal microbiota play a key role in the accumulation of uremic toxins due to the fact that numerous uremic solutes are generated in the process of protein fermentation by colonic microbiota. Some disease states, including CKD, are associated with the presence of dysbiosis, which can be defined as an "imbalanced intestinal microbial community with quantitative and qualitative changes in the composition and metabolic activities of the gut microbiota". The results of studies have confirmed the altered composition and functions of gut microbial community in chronic kidney disease. In the course of CKD protein-bound uremic toxins, including indoxyl sulfate, p-cresyl glucuronide, p-cresyl sulfate and indole-3-acetic acid are progressively accumulated. The presence of chronic kidney disease may be accompanied by the development of intestinal inflammation and epithelial barrier impairment leading to hastened systemic translocation of bacterial-derived uremic toxins and consequent oxidative stress injury to the kidney, cardiovascular and endocrine systems. These findings offer new therapeutic possibilities for the management of uremia, inflammation and kidney disease progression and the prevention of adverse outcomes in CKD patients. It seems that dietary interventions comprising prebiotics, probiotics, and synbiotics could pose a promising strategy in the management of uremic toxins in CKD.


Assuntos
Bactérias/metabolismo , Microbioma Gastrointestinal , Intestinos/microbiologia , Insuficiência Renal Crônica/sangue , Toxinas Biológicas/sangue , Uremia/sangue , Animais , Suplementos Nutricionais , Progressão da Doença , Disbiose , Interações Hospedeiro-Patógeno , Humanos , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/microbiologia , Insuficiência Renal Crônica/terapia , Uremia/diagnóstico , Uremia/microbiologia , Uremia/terapia
7.
Toxins (Basel) ; 13(4)2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33807387

RESUMO

Optical monitoring of spent dialysate has been used to estimate the removal of water-soluble low molecular weight as well as protein-bound uremic toxins from the blood of end stage kidney disease (ESKD) patients. The aim of this work was to develop an optical method to estimate the removal of ß2-microglobulin (ß2M), a marker of middle molecule (MM) uremic toxins, during hemodialysis (HD) treatment. Ultraviolet (UV) and fluorescence spectra of dialysate samples were recorded from 88 dialysis sessions of 22 ESKD patients, receiving four different settings of dialysis treatments. Stepwise regression was used to obtain the best model for the assessment of ß2M concentration in the spent dialysate. The correlation coefficient 0.958 and an accuracy of 0.000 ± 0.304 mg/L was achieved between laboratory and optically estimated ß2M concentrations in spent dialysate for the entire cohort. Optically and laboratory estimated reduction ratio (RR) and total removed solute (TRS) of ß2M were not statistically different (p > 0.35). Dialytic elimination of MM uremic toxin ß2M can be followed optically during dialysis treatment of ESKD patients. The main contributors to the optical signal of the MM fraction in the spent dialysate were provisionally identified as tryptophan (Trp) in small peptides and proteins, and advanced glycation end-products.


Assuntos
Soluções para Hemodiálise/análise , Falência Renal Crônica/terapia , Diálise Renal , Toxinas Biológicas/sangue , Uremia/terapia , Microglobulina beta-2/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Produtos Finais de Glicação Avançada/sangue , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Ligação Proteica , Espectrometria de Fluorescência , Espectrofotometria Ultravioleta , Resultado do Tratamento , Triptofano/sangue , Uremia/sangue , Uremia/diagnóstico
8.
Toxins (Basel) ; 13(4)2021 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-33808345

RESUMO

Accumulation of uremic toxins represents one of the major contributors to the rapid progression of chronic kidney disease (CKD), especially in patients with end-stage renal disease that are undergoing dialysis treatment. In particular, protein-bound uremic toxins (PBUTs) seem to have an important key pathophysiologic role in CKD, inducing various cardiovascular complications. The removal of uremic toxins from the blood with dialytic techniques represents a proved approach to limit the CKD-related complications. However, conventional dialysis mainly focuses on the removal of water-soluble compounds of low and middle molecular weight, whereas PBTUs are strongly protein-bound, thus not efficiently eliminated. Therefore, over the years, dialysis techniques have been adapted by improving membranes structures or using combined strategies to maximize PBTUs removal and eventually prevent CKD-related complications. Recent findings showed that adsorption-based extracorporeal techniques, in addition to conventional dialysis treatment, may effectively adsorb a significant amount of PBTUs during the course of the sessions. This review is focused on the analysis of the current state of the art for blood purification strategies in order to highlight their potentialities and limits and identify the most feasible solution to improve toxins removal effectiveness, exploring possible future strategies and applications, such as the study of a synergic approach by reducing PBTUs production and increasing their blood clearance.


Assuntos
Diálise Renal , Insuficiência Renal Crônica/terapia , Toxinas Biológicas/sangue , Uremia/terapia , Adsorção , Animais , Humanos , Ligação Proteica , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Resultado do Tratamento , Uremia/sangue , Uremia/diagnóstico
9.
Toxins (Basel) ; 13(4)2021 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-33921862

RESUMO

The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.


Assuntos
Dieta com Restrição de Proteínas , Falência Renal Crônica/terapia , Diálise Renal , Toxinas Biológicas/sangue , Uremia/terapia , Biomarcadores/sangue , Terapia Combinada , Dieta com Restrição de Proteínas/efeitos adversos , Progressão da Doença , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Diálise Renal/efeitos adversos , Resultado do Tratamento , Uremia/sangue , Uremia/diagnóstico , Uremia/fisiopatologia
10.
Int J Mol Sci ; 22(6)2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33799511

RESUMO

In uremic patients, high-density lipoprotein (HDL) loses its anti-inflammatory features and can even become pro-inflammatory due to an altered protein composition. In chronic kidney disease (CKD), impaired functions of polymorphonuclear leukocytes (PMNLs) contribute to inflammation and an increased risk of cardiovascular disease. This study investigated the effect of HDL from CKD and hemodialysis (HD) patients on the CD14 expression on PMNLs. HDL was isolated using a one-step density gradient centrifugation. Isolation of PMNLs was carried out by discontinuous Ficoll-Hypaque density gradient centrifugation. CD14 surface expression was quantified by flow cytometry. The activity of the small GTPase Rac1 was determined by means of an activation pull-down assay. HDL increased the CD14 surface expression on PMNLs. This effect was more pronounced for HDL isolated from uremic patients. The acute phase protein serum amyloid A (SAA) caused higher CD14 expression, while SAA as part of an HDL particle did not. Lipid raft disruption with methyl-ß-cyclodextrin led to a reduced CD14 expression in the absence and presence of HDL. HDL from healthy subjects but not from HD patients decreased the activity of Rac1. Considering the known anti-inflammatory effects of HDL, the finding that even HDL from healthy subjects increased the CD14 expression was unexpected. The pathophysiological relevance of this result needs further investigation.


Assuntos
Receptores de Lipopolissacarídeos/genética , Lipoproteínas HDL/farmacologia , Neutrófilos/efeitos dos fármacos , Insuficiência Renal Crônica/genética , Uremia/genética , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Receptores de Lipopolissacarídeos/metabolismo , Lipoproteínas HDL/isolamento & purificação , Masculino , Microdomínios da Membrana/química , Microdomínios da Membrana/efeitos dos fármacos , Microdomínios da Membrana/metabolismo , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Neutrófilos/patologia , Cultura Primária de Células , Diálise Renal , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/terapia , Proteína Amiloide A Sérica/genética , Proteína Amiloide A Sérica/metabolismo , Uremia/metabolismo , Uremia/fisiopatologia , Uremia/terapia , beta-Ciclodextrinas/farmacologia , Proteínas rac1 de Ligação ao GTP/genética , Proteínas rac1 de Ligação ao GTP/metabolismo
11.
Toxins (Basel) ; 13(4)2021 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-33805509

RESUMO

The aim of this systematic review is to investigate the effects of the use of a medium cut-off membrane (MCO) and dietary fiber on the concentration of protein-bound uremic toxins (PBUTs) and inflammatory markers in hemodialysis (HD) patients. Of 11,397 papers originally found, eight met the criteria of randomized controlled trial design. No study examined the effects of MCO membranes on PBUTs. Three studies examined the reduction in inflammatory markers with MCO membranes compared to high-flux HD membranes and showed no significant differences. Five studies of dietary fiber supplementation showed an inconclusive positive effect on PBUT levels and a significant positive effect on the reduction in inflammatory markers (interleukin-6 reduction: standardized difference in means -1.18; 95% confidence interval -1.45 to -0.9 for dietary fiber supplementation vs. control; p < 0.001). To date, no study has combined the use of an MCO membrane and fiber supplementation to reduce PBUT levels and inflammation with online hemodiafiltration as a comparator. A rationale and protocol for an interventional trial using a combination of MCO membrane dialysis and fiber supplementation to lower inflammatory markers and PBUT concentrations are presented.


Assuntos
Fibras na Dieta/administração & dosagem , Mediadores da Inflamação/sangue , Membranas Artificiais , Diálise Renal/instrumentação , Insuficiência Renal Crônica/terapia , Toxinas Biológicas/sangue , Uremia/terapia , Animais , Terapia Combinada , Filtração/instrumentação , Humanos , Ligação Proteica , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Resultado do Tratamento , Uremia/sangue , Uremia/diagnóstico
12.
J Stroke Cerebrovasc Dis ; 30(9): 105651, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33581988

RESUMO

Chronic kidney disease and seizures often co-exist. When seizures are provoked in patients with kidney disease, their treatment poses a particular challenge. Seizures may be provoked in the context of uremia, and toxic substances associated with uremic encephalopathy. In that case, the mainstay of therapy is to treat the uremia before consideration for anticonvulsant therapy. Treatment of seizures in the setting of chronic kidney disease requires special attention to selection of anticonvulsant medications and knowledge of the altered pharmacokinetics of these medications, which may require special titration schedule in that setting. The purpose of this review is to summarize the current knowledge about inter-relation of seizures and kidney disease. The review will also help practitioners who treat patients with renal failure and coexisting seizures in choosing the best treatment options.


Assuntos
Anticonvulsivantes/uso terapêutico , Ondas Encefálicas/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Epilepsia/tratamento farmacológico , Nefropatias/terapia , Diálise Renal , Uremia/terapia , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/farmacocinética , Encéfalo/fisiopatologia , Eletroencefalografia , Epilepsia/diagnóstico , Epilepsia/etiologia , Epilepsia/fisiopatologia , Humanos , Nefropatias/complicações , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Diálise Renal/efeitos adversos , Fatores de Risco , Resultado do Tratamento , Uremia/complicações , Uremia/diagnóstico , Uremia/fisiopatologia
13.
Toxins (Basel) ; 13(2)2021 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-33557434

RESUMO

Protein-bound uremic toxins (PBUTs) are difficult to remove using conventional dialysis treatment owing to their high protein-binding affinity. As pH changes the conformation of proteins, it may be associated with the binding of uremic toxins. Albumin conformation at pH 2 to 13 was analyzed using circular dichroism. The protein binding behavior between indoxyl sulfate (IS) and albumin was examined using isothermal titration calorimetry. Albumin with IS, and serum with IS, p-cresyl sulfate, indole acetic acid or phenyl sulfate, as well as serum from hemodialysis patients, were adjusted pH of 3 to 11, and the concentration of the free PBUTs was measured using mass spectrometry. Albumin was unfolded at pH < 4 or >12, and weakened interaction with IS occurred at pH < 5 or >10. The concentration of free IS in the albumin solution was increased at pH 4.0 and pH 11.0. Addition of human serum to each toxin resulted in increased free forms at acidic and alkaline pH. The pH values of serums from patients undergoing hemodialysis adjusted to 3.4 and 11.3 resulted in increased concentrations of the free forms of PBUTs. In conclusion, acidic and alkaline pH conditions changed the albumin conformation and weakened the protein binding property of PBUTs in vitro.


Assuntos
Insuficiência Renal Crônica/sangue , Albumina Sérica Humana/metabolismo , Toxinas Biológicas/sangue , Toxinas Biológicas/metabolismo , Uremia/sangue , Calorimetria , Dicroísmo Circular , Cresóis/sangue , Humanos , Concentração de Íons de Hidrogênio , Indicã/sangue , Ácidos Indolacéticos/sangue , Ligação Proteica , Conformação Proteica , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Albumina Sérica Humana/química , Ésteres do Ácido Sulfúrico/sangue , Uremia/diagnóstico , Uremia/terapia
14.
Int J Artif Organs ; 44(3): 165-173, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32842823

RESUMO

BACKGROUND: Regional citrate anticoagulation has been recommended as first choice for anticoagulation of continuous renal replacement therapy. Precise calcium supplementation is important for the safety of regional citrate anticoagulation. In this study we aimed to provide an optimized calcium supplementation approach for regional citrate anticoagulation in post-dilution continuous venous-venous hemodiafiltration. METHODS: Twenty-seven patients receiving post-dilution continuous venous-venous hemodiafiltration anticoagulated by citrate were included in this study. The ionized calcium levels were monitored and maintained in the targeted range. After linear regression analysis of the clearance of non-protein bound calcium and calculating the ratio of the non-protein bound calcium concentration to total calcium concentration, we concluded the mathematical model for calcium supplementation. RESULTS: Positive correlations were found between the clearance of non-protein bound calcium and both dialysate flow rates (r = 0.647, p < 0.001) and ultrafiltration plus substitution fluid flow rates (r = 0.525, p = 0.005). The ratio of the non-protein bound calcium concentration to total calcium concentration values at the pre-filter point after infusion of citrate were constant about 0.83. Based on the clearance and the calcium ratio, the amount of extracorporeal calcium removal can be estimated with a simplified equation. CONCLUSIONS: We provided an optimized calcium supplementation approach for post-dilution continuous venous-venous hemodiafiltration anticoagulated by citrate which may help to estimate the amount of extracorporeal circuit removal of calcium with regard to different dosages of regional citrate anticoagulation.


Assuntos
Cálcio/administração & dosagem , Ácido Cítrico/farmacologia , Uremia , Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Terapia de Substituição Renal Contínua/métodos , Soluções para Diálise/farmacologia , Suplementos Nutricionais , Relação Dose-Resposta a Droga , Feminino , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Uremia/sangue , Uremia/diagnóstico , Uremia/etiologia , Uremia/terapia
15.
Int J Artif Organs ; 44(3): 156-164, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32820982

RESUMO

The evidence on impact of intradialytic exercise on the removal of urea, is conflictive. Impact of exercise on kinetics of serum levels of protein-bound uraemic toxins, known to exert toxicity and to have kinetics dissimilar of those of urea, has so far not been explored. Furthermore, if any effect, the most optimal intensity, time point and/or required duration of intradialytic exercise to maximise removal remain obscure. We therefore studied the impact of different intradialytic cycling schedules on the removal of protein-bound uraemic toxins during haemodialysis (HD).This randomised cross-over study included seven stable patients who were dialysed with an FX800 dialyser during three consecutive midweek HD sessions of 240 min: (A) without cycling; (B) cycling for 60 min between 60th and 120th minutes of dialysis; and (C) cycling for 60 min between 150th and 210th minutes, with the same cycling load as in session B. Blood and dialysate flows were respectively 300 and 500 mL/min. Blood was sampled from the blood inlet at different time points, and dialysate was partially collected (300 mL/h). Small water soluble solutes and protein-bound toxins were quantified and intradialytic reduction ratios (RR) and overall removal were calculated per solute.Total solute removal and reduction ratios were not different between the three test sessions, except for the reduction ratios RR60-120 and RR150-210 for potassium.In conclusion, we add evidence to the existing literature that, regardless of the timing within the dialysis session, intradialytic exercise has no impact on small solute clearance, and demonstrated also a lack of impact for protein-bound solutes.


Assuntos
Falência Renal Crônica , Diálise Renal/métodos , Ureia , Uremia , Idoso , Coleta de Amostras Sanguíneas/métodos , Estudos Cross-Over , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Desintoxicação por Sorção/métodos , Fatores de Tempo , Toxinas Biológicas/sangue , Toxinas Biológicas/isolamento & purificação , Resultado do Tratamento , Ureia/sangue , Ureia/isolamento & purificação , Uremia/sangue , Uremia/terapia
16.
Curr Opin Nephrol Hypertens ; 30(1): 75-84, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33148949

RESUMO

PURPOSE OF REVIEW: Gut dysbiosis has been implicated in the pathogenesis of chronic kidney disease (CKD). Interventions aimed at restoring gut microbiota have emerged as a potential therapeutic option in CKD. This review summarizes the current evidence on gut microbiota-targeted strategies in patients with CKD. RECENT FINDINGS: A growing number of studies have shown that plant-based diets, low-protein diets, prebiotic, probiotic, and synbiotic supplementation, and constipation treatment may lead to favorable alterations in the gut microbiota. Current evidence suggests that the implementation of both plant-based and low-protein diets has potential benefits for the primary prevention of CKD, and for slowing CKD progression, with minimal risk of hyperkalemia and/or cachexia. The use of prebiotics, probiotics, and synbiotics and laxatives may have beneficial effects on uremic toxin generation, but their evidence is limited for the prevention and treatment of CKD. Recent advances in diagnostic technologies (e.g., high-throughput sequencing and nanotechnology) could enhance rapid diagnosis, monitoring, and design of effective therapeutic strategies for mitigating gut dysbiosis in CKD. SUMMARY: Plant-based and low-protein diets, prebiotic, probiotic, and synbiotic supplementation, and constipation treatment represent novel gut microbiota-targeted strategies in the conservative management of CKD, which could improve clinical outcomes in CKD.


Assuntos
Constipação Intestinal , Disbiose , Microbioma Gastrointestinal , Enteropatias , Insuficiência Renal Crônica , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Dieta com Restrição de Proteínas , Dieta Vegetariana , Progressão da Doença , Disbiose/complicações , Disbiose/diagnóstico , Disbiose/microbiologia , Disbiose/terapia , Microbioma Gastrointestinal/genética , Microbioma Gastrointestinal/fisiologia , Humanos , Enteropatias/complicações , Enteropatias/diagnóstico , Enteropatias/microbiologia , Enteropatias/terapia , Laxantes/uso terapêutico , Nanotecnologia , Prebióticos/administração & dosagem , Probióticos/uso terapêutico , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/prevenção & controle , Insuficiência Renal Crônica/terapia , Simbióticos/administração & dosagem , Uremia/etiologia , Uremia/terapia
17.
Curr Opin Nephrol Hypertens ; 30(1): 97-107, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33186220

RESUMO

PURPOSE OF REVIEW: In advanced chronic kidney disease (CKD) patients with progressive uremia, dialysis has traditionally been the dominant treatment paradigm. However, there is increasing interest in conservative and preservative management of kidney function as alternative patient-centered treatment approaches in this population. RECENT FINDINGS: The primary objectives of conservative nondialytic management include optimization of quality of life and treating symptoms of end-stage renal disease (ESRD). Dietetic-nutritional therapy can be a cornerstone in the conservative management of CKD by reducing glomerular hyperfiltration, uremic toxin generation, metabolic acidosis, and phosphorus burden. Given the high symptom burden of advanced CKD patients, routine symptom assessment using validated tools should be an integral component of their treatment. As dialysis has variable effects in ameliorating symptoms, palliative care may be needed to manage symptoms such as pain, fatigue/lethargy, anorexia, and anxiety/depression. There are also emerging treatments that utilize intestinal (e.g., diarrhea induction, colonic dialysis, oral sorbents, gut microbiota modulation) and dermatologic pathways (e.g., perspiration reduction) to reduce uremic toxin burden. SUMMARY: As dialysis may not confer better survival nor improved patient-centered outcomes in certain patients, conservative management is a viable treatment option in the advanced CKD population.


Assuntos
Tratamento Conservador , Insuficiência Renal Crônica/terapia , Terapias Complementares , Humanos , Terapia Nutricional , Cuidados Paliativos , Assistência Centrada no Paciente , Qualidade de Vida , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Uremia/terapia
19.
Toxins (Basel) ; 12(10)2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-33003628

RESUMO

The cardiorenal syndrome relates to the detrimental interplay between the vascular system and the kidney. The uremic milieu induced by reduced kidney function alters the phenotype of vascular smooth muscle cells (VSMC) and promotes vascular calcification, a condition which is strongly linked to cardiovascular morbidity and mortality. Biological mechanisms involved include generation of reactive oxygen species, inflammation and accelerated senescence. A better understanding of the vasotoxic effects of uremic retention molecules may reveal novel avenues to reduce vascular calcification in CKD. The present review aims to present a state of the art on the role of uremic toxins in pathogenesis of vascular calcification. Evidence, so far, is fragmentary and limited with only a few uremic toxins being investigated, often by a single group of investigators. Experimental heterogeneity furthermore hampers comparison. There is a clear need for a concerted action harmonizing and standardizing experimental protocols and combining efforts of basic and clinical researchers to solve the complex puzzle of uremic vascular calcification.


Assuntos
Síndrome Cardiorrenal/metabolismo , Rim/metabolismo , Músculo Liso Vascular/metabolismo , Insuficiência Renal Crônica/metabolismo , Toxinas Biológicas/metabolismo , Uremia/metabolismo , Calcificação Vascular/metabolismo , Animais , Síndrome Cardiorrenal/patologia , Síndrome Cardiorrenal/fisiopatologia , Síndrome Cardiorrenal/terapia , Humanos , Rim/patologia , Rim/fisiopatologia , Músculo Liso Vascular/patologia , Músculo Liso Vascular/fisiopatologia , Prognóstico , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/terapia , Uremia/patologia , Uremia/fisiopatologia , Uremia/terapia , Calcificação Vascular/patologia , Calcificação Vascular/fisiopatologia , Calcificação Vascular/terapia
20.
Toxins (Basel) ; 12(10)2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33019590

RESUMO

Uremic toxins (UTs) generally accumulate in patients developing end-stage renal disease (ESRD). Although some kinds of UTs cause early death after starting hemodialysis (HD), it remains unknown whether the degree of excessive accumulation of various UTs is associated with worsening of prognosis. We retrospectively conducted this cohort study consisting of adult patients developing ESRD who initiated HD at the National Center for Global Health and Medicine from 2010 to 2019. We created a new uremic score, which was defined as the aggregate score of the following variables reflecting uremic state: elevated blood urea nitrogen, ß2-microglobulin, and anion gap before starting HD. The primary outcome was early mortality within 1-year after HD commencement. The hazard ratio (HR) and 95% confidence interval (CI) for a one-point increase in uremic score was calculated with Cox proportional hazard models adjusted by baseline conditions. We included 230 participants, 16 of whom experienced the primary outcome of early mortality after HD commencement. Uremic score was significantly associated with the primary outcome (crude HR: 1.91, 95% CI 1.16-3.14; adjusted HR: 4.19, 95% CI 1.79-9.78). Our novel uremic score, reflecting accumulation of specific UTs, more precisely predicts early mortality after HD commencement.


Assuntos
Falência Renal Crônica/terapia , Diálise Renal/mortalidade , Toxinas Biológicas/sangue , Uremia/terapia , Equilíbrio Ácido-Base , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Nitrogênio da Ureia Sanguínea , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima , Uremia/sangue , Uremia/diagnóstico , Uremia/mortalidade , Microglobulina beta-2/sangue
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